title: Comparative study of bronchial artery revascularization in lung transplantation.
abstract: OBJECTIVE
  Restoring dual blood supply to transplanted lungs by bronchial artery revascularization (BAR) remains controversial. We compared outcomes after lung transplantation performed with and without BAR.
  
  
  METHODS
  From December 2007 to July 2010, 283 patients underwent transplantation; 187 were 18 years or older, without previous or concomitant cardiac surgery. Of these patients, 27 underwent BAR in a pilot study to test success, safety, effectiveness, and teachability. A propensity score was generated to match BAR patients and 54 routine non-BAR patients. Follow-up was 1.3 ± 0.68 years.
  
  
  RESULTS
  BAR was angiographically successful in 26 (96%) of 27 patients. BAR and non-BAR patients had similar skin-to-skin time (P = .07) and postoperative hospital stays (P = .2), but more reoperations for bleeding (P = .002). Tracheostomy was performed in 9 (33%) of 27 BAR and 10 (19%) of 54 non-BAR patients (P = .2, log-rank). One BAR (3.7%) and 4 non-BAR (7.4%) patients required extracorporeal membrane oxygenation (P = .7). Airway ischemia was observed in 1 BAR (3.7%) versus 12 non-BAR (22%) patients (P = .03); anastomotic intervention was required in no BAR versus 8 non-BAR (15%) patients (P = .04). Hospital mortality was 1 of 27 versus 2 of 54 (P = .9). BAR patients had lower early biopsy tissue rejection grades (P = .008) and fewer pulmonary (P < .04) and bloodstream (P < .02) infections. Forced 1-second expiratory volume was similar (P > .2); 3 BAR versus 9 non-BAR patients developed bronchiolitis obliterans syndrome (BOS) (P = .14, log-rank). During follow-up, 4 BAR and 8 non-BAR patients died (P = .6, log-rank).
  
  
  CONCLUSIONS
  BAR is safe, with comparable early outcomes. Benefits of BAR include reduced airway ischemia and complications, lower biopsy tissue grades, fewer infections, and delay of BOS. A multicenter study is needed to establish these benefits.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: petterg@ccf.org.
authors.forename: Gösta B
authors.initials: GB
authors.lastname: Pettersson
authors.forename: Karam
authors.initials: K
authors.lastname: Karam
authors.forename: Lucy
authors.initials: L
authors.lastname: Thuita
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Johnston
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: McCurry
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
authors.forename: Marie M
authors.initials: MM
authors.lastname: Budev
authors.forename: Robin K
authors.initials: RK
authors.lastname: Avery
authors.forename: David P
authors.initials: DP
authors.lastname: Mason
authors.forename: Sudish C
authors.initials: SC
authors.lastname: Murthy
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000328:Adult; D000368:Aged; D001981:Bronchial Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000628:therapy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009820:Ohio; D010865:Pilot Projects; D057216:Propensity Score; D011859:Radiography; D012086:Reoperation; D012141:Respiratory Tract Infections / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: % of predicted FEV1; 12; BAR; BOS; CL; CPB; FEV1; FEV1%; IRB; Institutional Review Board; OB; PGD; bronchial artery revascularization; bronchiolitis obliterans syndrome; cardiopulmonary bypass; confidence limit; forced 1-second expiratory volume; obliterative bronchiolitis; primary graft dysfunction